Posted By Janet Hui , MPH,
Friday, April 7, 2017
Updated: Friday, March 31, 2017
This February, CSTE attended the 2017 HIMSS Annual Conference and Exhibition in Orlando, Florida. HIMSS – the Healthcare Information and Management Systems Society – is a global non-profit whose mission is to improve health through information technology. Their annual conference is one of the largest health IT conferences in the world, with over 40,000 representatives from health care and health IT attending this year. The enormous HIMSS exhibit hall featured some of the biggest names in health care and technology, such as Allscripts, Cerner, Epic IBM and many others.
This year, CSTE was invited by CDC to participate in the HIMSS Interoperability Showcase to demonstrate the Reportable Conditions Knowledge Management System (RCKMS). The Interoperability Showcase is a guided exhibit at HIMSS, where companies and organizations partner together and demonstrate how different technologies can work together to address a health problem. For our use case, CSTE partnered with the Association of Public Health Laboratories (APHL), Utah Department of Health, Epic and others to demonstrate how new technologies and standards can be used to enhance public health (PH) surveillance. Together, we demonstrated the electronic case reporting flow for a potential case of Zika virus infection.
During the Showcase, we simulated a patient visiting a clinic in Utah and receiving a positive PCR result for Zika virus, which triggered the process of PH reporting. The clinic’s EHR, represented by Epic, built and sent an initial electronic case report (elCR) to the APHL AIMS platform, which invoked the RCKMS decision support service to determine that this potential case should be reported to Utah Department of Health. AIMS routed the eICR and a Reportability Response (RR) to the Utah Department of Health and a RR to the Epic EHR system. Utah consumed the eICR and RR into their surveillance system, and Epic received and processed the RR.
Pictured: CSTE staff member Janet Hui leads a demonstration of the Reportable Conditions Knowledge Management System (RCKMS) during the 2017 HIMSS Conference in Orlando, FL.
Overall, CSTE’s participation in this year’s HIMSS Conference was very productive in educating attendees on CSTE’s role in the work of public health reporting, RCKMS and other technology currently being developed in the surveillance/reporting realm. The Conference presented a great opportunity to engage fellow public health professionals on the ongoing work of RCKMS, and I look forward to participation in future HIMSS Conferences.
Janet Hui is CSTE’s Associate Research Analyst on the RCKMS initiative. For more information about the ongoing RCKMS work or other projects in the Surveillance/Informatics area, contact Janet at firstname.lastname@example.org.
Posted By Erica Washington, MPH, CPH, CIC, CPHQ,
Friday, February 17, 2017
Updated: Wednesday, February 15, 2017
When considering the state of antibiotic resistance proliferation in today's health care landscape, the words “The Bugs are Fighting Back!” may come to mind. While this may sound like a D-list ‘80s movie, it succinctly summarizes the rapid pace of antibiotic resistance evolution, and the urgent need for stewardship in prescribing and surveillance practices. Antibiotics are ubiquitous in today's society: they are in foods, prescribed as medicine and at one point were even widely used in soaps. Each of these factors spurned the growth of resistant organisms for which antibiotics have reduced efficacy. Some consequences of antibiotic-resistant infections are longer and more complicated illnesses, increased doctor visits and increased mortality. In light of the vast problem of existing and emerging resistance, I chose to address surveillance of antibiotic prescribing practices and antibiotic threats as my project for my Informatics-Training in Place Program (I-TIPP) fellowship.
I join a myriad of stakeholders who have focused their attention on the need for antibiotic stewardship over the last several years. These efforts to combat antibiotic-resistant bacteria were propelled further by the 2015 White House Report titled National Action Plan for Combating Antibiotic-Resistant Bacteria. The report established several goals to fight “super bugs,” such as reducing the incidence of Clostridium difficile by 50 percent, reducing carbapenem-resistant Enterobacteriaceae infections by 60 percent, and maintaining the prevalence of ceftriaxone-resistant Neisseria gonorrhoeae below two percent (of all of the multi-drug resistant organisms, stating the emergence of Gonorrhoeae as a drug-resistant threat typically gets the biggest gasp from my audiences of infection preventionists and stakeholders).
The need for antibiotic stewardship is readily apparent in Louisiana, where I am pursuing my fellowship in theLouisiana Department of Health. According to Centers for Disease Control and Prevention's (CDC) Healthcare-Associated Infections 2015 Prevention Status Report, only 29.5 percent of acute care hospitals in Louisiana reported having antibiotic stewardship programs that incorporated all seven core elements deemed critical by CDC. These seven core elements include leadership commitment, accountability, drug expertise, action, tracking, reporting and education. Although this data references only acute care hospitals, antibiotic stewardship is needed across the health care spectrum. The seven core elements for antibiotic stewardship are recommended for implementation in all settings where prescribing occurs, including long-term acute care hospitals and nursing homes.
Similar to the Prevention Status Report's revelation of lack of antibiotic stewardship programs, CDC's 2014 Community Antibiotic Prescriptions Report shows data demonstrating that Louisiana's doctors' offices, emergency departments and hospital clinics administer antibiotics that are unnecessary at a rate of 1,021-1,285 prescriptions per 1,000. Overprescribing can be attributed to a number of factors. One study published in British Journal of General Practice showed that reduced antibiotic prescribing is associated with lower patient satisfaction, which may be why doctors overprescribe unnecessary medications. According to The Pew Charitable Trusts (PCT), common inappropriate uses of antibiotics in health care are for asthma, allergies, bronchitis, middle ear infections, influenza, viral pneumonia and viral upper respiratory infections. PCT has listed reducing inappropriate antibiotic use for all conditions by 50 percent by 2020 as a national goal.
Through my I-TIPP fellowship, I have identified current informatics capacities at acute care hospitals, promoted use of the National Healthcare Safety Network's (NHSN) Antibiotic Use and Resistance Module (AUR), educated facilities about the need for robust antibiotic stewardship activities and notified acute care hospitals about the eligibility of Meaningful Use Stage 3 incentives for participating in both the antibiotic use and antibiotic resistance features of the AUR. In July 2016, I conducted an introductory webinar on the AUR and in September 2016, I conducted a survey among acute care NHSN users to assess their electronic reporting capacities to participate in the AUR. Information administered in the initial webinar on AUR was reinforced at three, in-person workshops that were presented statewide in November 2016. These workshops focused on the NHSN and Emerging Infectious Disease, which are an integral part of Louisiana's health care-associated infections activities. Infection preventionists and patient safety personnel were the target audience for these workshops, however some pharmacists participated as well, in light of the demonstration of the AUR Module.
Effectively intersecting with people to generate outcomes that impact population health has been the key to my success in the fellowship thus far. Understanding the needs of each facility that has indicated an interest in signing up for the AUR Module, determining what their current capacities and barriers to creating competent antibiotic stewardship programs, and showing how Meaningful Use participation can help them has been integral to my project. Through I-TIPP, I have been able to refine my communication skills and problem solving methods to achieve public health goals that will better the health of Louisianans as we fight back against super bugs.
CSTE Fellow Erica Washington presents content on the NHSN Antibiotic Use/Resistance Module at the annual Louisiana National Healthcare Safety Network/Emerging Infectious Diseases Workshops in Bossier City, LA at Willis-Knighton Health Center in November 2016.
Erica Washington is an Informatics-Training in Place Program Fellow at the Louisiana Department of Health. She received her MPH from Tulane University in New Orleans, LA. Ms. Washington's post is the fifth in a series of blogs by CSTE-sponsored fellows.
Posted By Juliet Sheridan, MPH,
Monday, January 23, 2017
Updated: Monday, January 23, 2017
As a self-proclaimed data nerd, I was initially excited about being accepted into the Applied Public Health Informatics Fellowship (APHIF) because I’d have the chance to improve my technical skills in a real-world setting. Supported by CDC, the Council of State and Territorial Epidemiologists (CSTE) and the National Association of County and City Health Officials (NACCHO), my APHIF work is part of the “Project SHINE” professional development collaboration. Imagine my surprise when my main fellowship project for the Family Success Alliance turned out to be more about people than the technical specs.
The Family Success Alliance (FSA) is a collective impact initiative developed to ensure that children whose families struggle to make ends meet have the educational and economic opportunities to succeed in Orange County, NC. Modeled after the Harlem Children’s Zone, FSA works in two neighborhoods called ‘Zones’ to provide a “pipeline” of evidence-based programs, services and supports from cradle to career. With over 200 participants in the first two years and yearly expansion planned, FSA needed a way to keep track of demographic, program and outcome information for each participant and their family.
The Family Success Alliance (FSA) is a collective impact initiative developed to ensure that children whose families struggle to make ends meet have the educational and economic opportunities to succeed in Orange County, NC.
Because the collaborative spans many sectors, including local government, school districts, non-profit organizations and funders, we couldn’t just set up a regular database. It was important to track not only what was happening, e.g., tracking participation in programming, but also how partners were interacting, e.g., whether the afterschool tutoring organization also referred participants to our mental health partners. We needed this tracking to occur in real-time across 13 different organizations, while also being HIPAA and FERPA compliant.
To this end, I was selected to implement a shared measurement system that all our partners could access and utilize. The United Way, one of our funders, uses a web-based case management system called Efforts to Outcomes (ETO), created by Social Solutions, Inc., which we decided to adopt for FSA. I focused first on the technical components necessary for success, such as gathering requirements, managing permissions and building reports. However, I realized that the most important pieces of this project were non-technical. How do you build trust among partners? Maintain common goals and accountability? Allow for unique organizational needs? Prioritize equity? These questions ultimately informed most of my work during my fellowship experience.
Pictured: FSA partners are pictured here during a working meeting.
Before I could begin setting up ETO, we had to create and sign a Master Data Sharing Agreement that outlined the appropriate use, storage, analysis and security for the data we would enter into our system. We found that this agreement could not move forward without numerous conversations about each partners’ experience with similar data, capacity for data management and expectations for security, confidentiality and privacy. Fundamentally, these conversations were about building trust. Do you and your partners trust each other to be good stewards of the data? Do your clients trust you to maintain their information in a secure way? The Data Sharing Agreement is just the first step in a continuing conversation about data use and practices; my role is to accompany our partners in that discussion.
Now that the Master Data Sharing Agreement is almost complete, I’ve turned my attention to getting the system set up for our community partners. In designing the forms and user interface on the website, it is crucial to keep the end goals of the collaborative in mind, so that we can measure the impact on the community. One of the guiding principles of the Alliance is equity, and that is no less true when it comes to data. This principle informs both logistical and measurement questions about our data, including who enters the data, how we train staff, if we are capturing community strengths, and whether we’re contributing to a “fixing systems” mentality instead of “fixing people”. The real questions we want to answer using this database are about families living in Orange County and whether their children are ready for kindergarten; if they have appropriate, stable housing; and if there more families living above the poverty line as a result of our work. If I focused only on the technical requirements of the database, I’d lose sight of what is truly important about the work we’re doing.
Pictured: Here, a teacher reads to children in the Kindergarten Readiness Program.
Through my APHIF experience, I’ve found that informatics is about so much more than just technical skills. Systems like ETO improve our processes and contribute to data-driven decision making, but they must also be designed with human “requirements” in mind, like trust, accountability and equity in order to be truly successful. I am so grateful to my mentors, our community partners, Family Success Alliance staff and funders for their continued support and assistance. The Orange County Health Department and the APHIF program have afforded me this unique opportunity that has changed the way I will approach public health informatics throughout my career.
Juliet Sheridan is an Applied Public Health Informatics Fellow at the Orange County Health Department in North Carolina. She received her MPH from the University of North Carolina at Chapel Hill. Ms. Sheridan’s post is the third in a series of blogs by CSTE-sponsored fellows.
Posted By Kenneth Scott, PhD, MPH,
Tuesday, January 10, 2017
2016 was a big year for Denver. In addition to the Denver Broncos’ Super Bowl championship, the regional transit agency introduced three new train lines, with a fourth coming soon, and Denver’s Mayor Michael Hancock launched an initiative known as “Vision Zero.” First enacted by the Swedish Parliament in 1997, Vision Zero was designed to eliminate all traffic-related deaths and serious injuries by 2020. That anyone in the 21st century could seriously imagine a city or country with no serious road traffic injuries is an indicator of how far public health and safety professionals have come in making transportation safer. Improved traffic safety has been a public health goal for decades, due in part to the early intellectual leadership of Dr. William Haddon Jr. as well as the political activism of Ralph Nader. The Center for Disease Control and Prevention (CDC) counts motor vehicle safety as one of the greatest public health achievements of the 20th century. Even so, Sweden’s notion that traffic deaths and serious injuries can be eradicated was, well… visionary.
In the first decade of Vision Zero, the number of road deaths in Sweden was cut in half. Other governments have since followed Sweden’s model, adopting Vision Zero policies of their own. In the United States, cities like Boston, Chicago and San Francisco have taken the lead with efforts to implement. Vision Zero in Denver, as in Sweden, has come both from community activism as well as political leadership. Mayor Hancock made a formal commitment to Vision Zero in February 2016 after receiving support from a network of community organizations in the Denver area. A group of city agencies is currently working to develop a Vision Zero Action Plan for Denver, with ongoing guidance from interested community groups.
Tracking progress in achieving Vision Zero requires data, which is where public health informatics comes in. Public health informatics is ultimately about transforming health-related data into useful information for public health action. I am currently a fellow working at Denver Public Health through the Applied Public Health Informatics Fellowship (APHIF) program. APHIF is supported by CDC, the Council of State and Territorial Epidemiologists (CSTE), and the National Association of County and City Health Officials (NACCHO) as part of the “SHINE” professional development collaboration. Fellows in my program are typically recent graduates of academic programs in public health or computer & information science (I defended my dissertation in epidemiology this past August). We receive one year of on-the-job training at a state or local health agency, where we learn how to communicate and work with the diverse teams of professionals involved in public health informatics.
In an effort to build injury epidemiology capacity within our department, I have been responding to information requests we receive related to injury prevention—my PhD focus. Denver Environmental Health—one of the agencies working on the Vision Zero Action Plan—requested that the Denver Public Health’s Public Health Informatics Group (PHIG) where I am embedded conduct a “hot spot” analysis of transportation injuries in the city. After evaluating different information systems, my fellowship mentors and I concluded that electronic health record data collected by Denver’s paramedics would be best suited to identify hazardous locations. Geographic location data assigned by the 911 call system are the most precise measures of injuries’ incident locations in any available health records. Also, the paramedic data capture injuries that police reports—which are publicly available and have previously been analyzed—might miss.
Through a partnership with the Denver Health Paramedics Division, we evaluated five years of transportation injury data and identified specific locations in Denver that might benefit from additional attention (e.g., intersection redesign, traffic enforcement, etc.). Denver Environmental Health and the other members of the Vision Zero work group will use our report to help develop recommendations to improve transportation safety in Denver. I look forward to seeing how the report is used.
What I have enjoyed the most about this fellowship has been working in an applied setting with committed public health practitioners and learning from professionals trained in other disciplines, including computer science, software development and database management. This cross cutting, interprofessional education is helping me and other fellows in my cohort build skills to translate across disciplines and, hopefully, secure long-term career placement in governmental public health. It has been rewarding to apply my formal education in epidemiology to public health issues and information systems specific to Denver—the city where I was born and raised. As a child, I was treated by Denver’s paramedics for injuries I sustained after running through a glass door. A surgeon at Denver Health helped me return to play after I experienced a shoulder injury playing high school football. And as a bike commuter, I have crossed through intersections that our analyses highlight for improvements. In other words, working with these particular information systems carries a personal significance for me. And from a professional standpoint, the APHIF program has given me valuable experience working in local public health which, as we say, is where the rubber meets the road.
Dr. Ken Scott is an Applied Public Health Informatics Fellow at Denver Public Health. He received his PhD from the University of Colorado and his MPH from the University of Washington. Dr. Scott’s post is the second in a series of blogs by CSTE-sponsored fellows.
Posted By Lauren Reeves,
Thursday, July 10, 2014
Updated: Thursday, July 10, 2014
“People are the most important; the systems are secondary.” Joe Gibson, Director of Epidemiology at the Marion County Public Health Department in Indiana, understands the importance of having capable people for public health and informatics capacity. He views epidemiology as decision support: getting the right information to the right people at the right time, to improve decisions affecting the health of the community. The belief in this process is underscored by Joe’s support of public health informatics training. Joe is a mentor in the Applied Public Health Informatics Fellowship program, which provides on-the-job training to recent graduates in order to increase public health informatics capacity.
The Fellow working in Marion County under Joe’s mentorship is Crystal Clay, a graduate student in the School of Informatics and Computing at Indiana University Purdue University in Indianapolis. Crystal has enjoyed her time as an APHIF Fellow, because she’s received more experience with informatics and has been able to learn about public health informaticians and public health practitioners. “I’ve learned a lot about the value of effective communication, a vital skill for public health informaticians,” Crystal adds. “Effectively engaging stakeholders is especially important in informatics, which involves interacting with a diverse workforce.” She says the mentorship model of the fellowship was extremely helpful in understanding the health department culture, the agency’s structure and dynamics, and completing projects.
Crystal has worked on several projects as a Fellow. One has dealt with Meaningful Use compliance, working with health department providers to teach them how to use the electronic prescribing system, and to adapt the system to the provider’s needs. “I created a training document and facilitated several training sessions to help providers improve care and ensure compliance,” she says.. “Marion County will continue to benefit from the progress Crystal has made,” Joe says. “She has made considerable progress on important informatics projects for our health department.”
Joe and Crystal both emphasize the role of informatics in public health and the role that business process analysis plays. Business process analysis helps get public health program staff to understand data and information as well as the technical side. Clearer business processes can streamline how public health works, making it more effective. Joe says that “public health increasingly needs rapid access to information. Both developing good information systems and paying attention to processes are important parts of achieving that.”
Perhaps the biggest indicator of the program’s success is the future. Joe says “I’d definitely continue a relationship with APHIF. The fellowship helps us train informaticians with great technical and public health skills.” Crystal, too, is looking towards the future and is interested in staying in public health. She also would like to serve as a mentor one day. “Mentors have played a monumental role in my success. It’s my desire to contribute to the development of other aspiring public health informaticians.”
For more information about the Applied Public Health Informatics Fellowship and other training programs offered by CSTE, including how to apply to be a mentor or a fellow, please visit www.aphif.org.
The CSTE Annual Conference was stimulating and thought provoking—there were many excellent examples of “epidemiology in action.” Attendees shared ideas and experiences, and created a real “community of practice.”
Now that we’re back from Nashville, I’m looking ahead to 2014–2015. Issues raised at the annual conference reinforced ideas I had about priorities for this coming year:
Informatics capacity continues to be a struggle, but we’re making progress. CSTE’s advocacy efforts educate policy makers to increase awareness and encourage funding. CSTE’s workforce development initiatives improve existing and new epidemiologists’ competencies in informatics skills. These continued efforts are important to sustain progress in this area.
Developments in laboratory technology are just beginning to have a huge impact on public health surveillance. We will have to adapt to these changes to preserve our ability to do effective surveillance.
Public health must align with the changes occurring in healthcare delivery and the focus on accountable care. Accountable care organizations (ACOs) are going to be responsible for the health of the populations in their care, not just their medical care. Public health epidemiologists should be the ones who are recognized as monitoring population health, identifying needs and holding ACOs truly accountable.
Hepatitis C, as a public health challenge, is entering a whole new level of complexity. Literally millions of cases are diagnosed and being diagnosed. We are entering an era of cure with more easily tolerated, shorter course, highly effective, but expensive therapy. We will be called on to define the burden and monitor trends, but we have never had the needed resources.
Together we can improve applied epidemiology, improve public health, and improve the health of our communities.
Alfred DeMaria, Jr. is the president of CSTE and the State Epidemiologist at the Massachusetts Department of Public Health.